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Hölzing CR, van der Linde J, Kersting S, Busemann A. Prevalence and characteristics of the 'bad feeling' among healthcare professionals in the context of emergency situations: A Bi-Hospital Survey. J Clin Nurs 2024. [PMID: 39010304 DOI: 10.1111/jocn.17374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 06/04/2024] [Accepted: 07/04/2024] [Indexed: 07/17/2024]
Abstract
INTRODUCTION Clinical decision-making is based on objective and subjective criteria, including healthcare workers impressions and feelings. This research examines the perception and implications of a 'bad feeling' experienced by healthcare professionals, focusing on its prevalence and characteristics. METHODS A cross-sectional paper-based survey was conducted from January to July 2023 at the University Medicine Greifswald and the hospital Sömmerda involving physicians, nurses, medical students and trainees from various specialties. With ethics committee approval, participants were recruited and surveyed at regular clinical events. Data analysis was performed using SPSS® Statistics. The manuscript was written using the Strobe checklist. RESULTS Out of 250 questionnaires distributed, 217 were valid for analysis after a 94.9% return rate and subsequent exclusions. Sixty-five per cent of respondents experience the 'bad feeling' occasionally to frequently. There was a significant positive correlation between the frequency of 'bad feeling' and work experience. The predominant cause of this feeling was identified as intuition, reported by 79.8% of participants, with 80% finding it often helpful in their clinical judgement. Notably, in 16.1% of cases, the 'bad feeling' escalated in the further clinical course into an actual emergency. Furthermore, 60% of respondents indicated that this feeling occasionally or often serves as an early indicator of a potential, yet unrecognised, emergency in patient care. CONCLUSIONS This study demonstrates the relevance of clinical experience to decision-making. As an expression of this, there is a correlation between the frequency of a 'bad feeling' and the number of years of experience. It is recommended that the 'bad feeling' be deliberately acknowledged and reinforced as an early warning signal for emergency situations, given its significant implications for patient safety. Future initiatives could include advanced training and research, as well as tools such as pocket maps, to better equip healthcare professionals in responding to this intuition.
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Affiliation(s)
- Carlos Ramon Hölzing
- Department of General, Visceral, Thoracic and Vascular Surgery, University of Greifswald, Greifswald, Germany
| | - Julia van der Linde
- Department of General, Visceral, Thoracic and Vascular Surgery, University of Greifswald, Greifswald, Germany
| | - Stephan Kersting
- Department of General, Visceral, Thoracic and Vascular Surgery, University of Greifswald, Greifswald, Germany
| | - Alexandra Busemann
- Department of General, Visceral, Thoracic and Vascular Surgery, University of Greifswald, Greifswald, Germany
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Elbi H, Tan MN, Yokus SE, Ozcan F, Mevsim V, Stolper E. The linguistic validation of the gut feelings questionnaire in Turkish. Eur J Gen Pract 2023; 29:2273846. [PMID: 37929745 PMCID: PMC10629413 DOI: 10.1080/13814788.2023.2273846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 10/09/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND 'Gut feelings' are frequently used by general practitioners in the clinical decision-making process, especially in situations of uncertainty. The Gut Feelings Questionnaire (GFQ) has been developed in the Netherlands and is now available in English, French, German, Polish, Spanish, and Catalan, enabling cross-border studies on the subject. However, a Turkish version of the GFQ is lacking. OBJECTIVES A Turkish version of the GFQ. METHODS A linguistic validation procedure was conducted, which took place in six phases: forward translation (step 1), backward translation (step 2), first consensus (step 3), cultural validation (step 4), second consensus (step 5), and final version (step 6). RESULTS The absence of literal equivalent of the term 'gut feelings' in Turkish was determined. The word 'intuition' was chosen as the Turkish literal equivalent of 'gut feelings'. There were also some challenges in finding the exact meanings of words and expressions in Turkish literature. However, we succeeded in finding adequate and responsible solutions. A Turkish version of the GFQ is available now. CONCLUSION With these validated GFQs, Turkish GPs can facilitate studies of the role of 'gut feelings' in clinical reasoning.
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Affiliation(s)
- Huseyin Elbi
- Department of Family Medicine, Manisa Celal Bayar University, Faculty of Medicine, Manisa, Turkey
| | - Makbule Neslişah Tan
- Department of Family Medicine, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Sidika Ece Yokus
- Department of Family Medicine, Manisa Celal Bayar University, Faculty of Medicine, Manisa, Turkey
| | - Fatih Ozcan
- Department of Family Medicine, Manisa Celal Bayar University, Faculty of Medicine, Manisa, Turkey
| | - Vildan Mevsim
- Department of Family Medicine, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Erik Stolper
- CAPHRI School for Public Health and Primary Care, University of Maastricht, Maastricht, The Netherlands
- Faculty of Medicine and Health Sciences, Department of Family Medicine and Population Health, University of Antwerp Antwerp, Belgium, Antwerp, Belgium
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Urbane UN, Petrosina E, Zavadska D, Pavare J. Integrating Clinical Signs at Presentation and Clinician's Non-analytical Reasoning in Prediction Models for Serious Bacterial Infection in Febrile Children Presenting to Emergency Department. Front Pediatr 2022; 10:786795. [PMID: 35547543 PMCID: PMC9082163 DOI: 10.3389/fped.2022.786795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Development and validation of clinical prediction model (CPM) for serious bacterial infections (SBIs) in children presenting to the emergency department (ED) with febrile illness, based on clinical variables, clinician's "gut feeling," and "sense of reassurance. MATERIALS AND METHODS Febrile children presenting to the ED of Children's Clinical University Hospital (CCUH) between April 1, 2017 and December 31, 2018 were enrolled in a prospective observational study. Data on clinical signs and symptoms at presentation, together with clinician's "gut feeling" of something wrong and "sense of reassurance" were collected as candidate variables for CPM. Variable selection for the CPM was performed using stepwise logistic regression (forward, backward, and bidirectional); Akaike information criterion was used to limit the number of parameters and simplify the model. Bootstrapping was applied for internal validation. For external validation, the model was tested in a separate dataset of patients presenting to six regional hospitals between January 1 and March 31, 2019. RESULTS The derivation cohort consisted of 517; 54% (n = 279) were boys, and the median age was 58 months. SBI was diagnosed in 26.7% (n = 138). Validation cohort included 188 patients; the median age was 28 months, and 26.6% (n = 50) developed SBI. Two CPMs were created, namely, CPM1 consisting of six clinical variables and CPM2 with four clinical variables plus "gut feeling" and "sense of reassurance." The area under the curve (AUC) for receiver operating characteristics (ROC) curve of CPM1 was 0.744 (95% CI, 0.683-0.805) in the derivation cohort and 0.692 (95% CI, 0.604-0.780) in the validation cohort. AUC for CPM2 was 0.783 (0.727-0.839) and 0.752 (0.674-0.830) in derivation and validation cohorts, respectively. AUC of CPM2 in validation population was significantly higher than that of CPM1 [p = 0.037, 95% CI (-0.129; -0.004)]. A clinical evaluation score was derived from CPM2 to stratify patients in "low risk," "gray area," and "high risk" for SBI. CONCLUSION Both CPMs had moderate ability to predict SBI and acceptable performance in the validation cohort. Adding variables "gut feeling" and "sense of reassurance" in CPM2 improved its ability to predict SBI. More validation studies are needed for the assessment of applicability to all febrile patients presenting to ED.
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Affiliation(s)
- Urzula Nora Urbane
- Department of Pediatrics, Riga Stradins University, Riga, Latvia.,Department of Pediatrics, Children's Clinical University Hospital, Riga, Latvia
| | - Eva Petrosina
- Statistics Unit, Riga Stradins University, Riga, Latvia
| | - Dace Zavadska
- Department of Pediatrics, Riga Stradins University, Riga, Latvia.,Department of Pediatrics, Children's Clinical University Hospital, Riga, Latvia
| | - Jana Pavare
- Department of Pediatrics, Riga Stradins University, Riga, Latvia.,Department of Pediatrics, Children's Clinical University Hospital, Riga, Latvia
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Dunne P, Livie V, McGowan A, Siu W, Chaudhary S, Groome M, Phull P, Fraser A, Morris AJ, Penman ID, Stanley AJ. Increasing the low-risk threshold for patients with upper gastrointestinal bleeding during the COVID-19 pandemic: a prospective, multicentre feasibility study. Frontline Gastroenterol 2021; 13:303-308. [PMID: 35712356 PMCID: PMC8390142 DOI: 10.1136/flgastro-2021-101851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/12/2021] [Indexed: 02/04/2023] Open
Abstract
Objective During the COVID-19 pandemic, we extended the low-risk threshold for patients not requiring inpatient endoscopy for upper gastrointestinal bleeding (UGIB) from Glasgow Blatchford Score (GBS) 0-1 to GBS 0-3. We studied the safety and efficacy of this change. Methods Between 1 April 2020 and 30 June 2020 we prospectively collected data on consecutive unselected patients with UGIB at five large Scottish hospitals. Primary outcomes were length of stay, 30-day mortality and rebleeding. We compared the results with prospective prepandemic descriptive data. Results 397 patients were included, and 284 index endoscopies were performed. 26.4% of patients had endoscopic intervention at index endoscopy. 30-day all-cause mortality was 13.1% (53/397), and 33.3% (23/69) for pre-existing inpatients. Bleeding-related mortality was 5% (20/397). 30-day rebleeding rate was 6.3% (25/397). 84 patients had GBS 0-3, of whom 19 underwent inpatient endoscopy, 0 had rebleeding and 2 died. Compared with prepandemic data in three centres, there was a fall in mean number of UGIB presentations per week (19 vs 27.8; p=0.004), higher mean GBS (8.3 vs 6.5; p<0.001) with fewer GBS 0-3 presentations (21.5% vs 33.3%; p=0.003) and higher all-cause mortality (12.2% vs 6.8%; p=0.02). Predictors of mortality were cirrhosis, pre-existing inpatient status, age >70 and confirmed COVID-19. 14 patients were COVID-19 positive, 5 died but none from UGIB. Conclusion During the pandemic when services were under severe pressure, extending the low-risk threshold for UGIB inpatient endoscopy to GBS 0-3 appears safe. The higher mortality of patients with UGIB during the pandemic is likely due to presentation of a fewer low-risk patients.
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Affiliation(s)
- Philip Dunne
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - Victoria Livie
- Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, UK
| | - Aaron McGowan
- Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Wilson Siu
- Department of Gastroenterology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Sardar Chaudhary
- Department of Gastroenterology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Maximillian Groome
- Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, UK
| | - Perminder Phull
- Department of Gastroenterology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Andrew Fraser
- Department of Gastroenterology, Queen Elizabeth University Hospital, Glasgow, UK
| | | | - Ian D Penman
- Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Adrian J Stanley
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
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Potakhin SN, Shapkin YG. Risk Factor Analysis And Method Development For Predicting The Recurrence Of Gastroduodenal Ulcer Bleeding. RUSSIAN OPEN MEDICAL JOURNAL 2020. [DOI: 10.15275/rusomj.2020.0419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective — To clarify clinical, laboratory and endoscopic signs of a high recurrence risk of gastroduodenal ulcer bleeding (GDUB) and to develop a multifactorial method for its prediction. Material and Methods — The research was completed over 2019-2020. The study took place in two stages. At the first stage, 409 patients with GDUB, who were treated at the emergency surgical department of Saratov City Clinical Hospital No. 6 from 1991 to 2000, were included in the study. During that time, endoscopic hemostasis therapy was used in a few cases, while modern antisecretory therapy has not yet been developed and carried out. Two groups of patients were compared: with recurrent bleeding (104 patients) and without recurrent bleeding (305 patients). At the second stage, a retrospective analysis of the outcomes of treating 126 patients with GDUB, cared for at the clinic from 2001 to 2009, was carried out. During this period of time, assistance for this pathology was the most complete and matched all current standards. The analysis included 63 patients with recurrent bleeding and 63 patients without recurrent bleeding. We conducted a comparative analysis of the developed method for predicting bleeding recurrence versus the classifications by J.A. Forrest (1974) and G.P. Giderim (1992) in our original modification. Results — At the first stage of the study, the most significant signs for predicting recurrent bleeding were identified as unstable hemodynamics, severity of blood loss, nature of vomiting, presence of concomitant pathology, state of the ulcer surface sensu J.A. Forrest; and localization, size and depth of the ulcer. We determined their informative value in assessing the risk of recurrent bleeding and developed a novel method of its prediction. Taken alone, each of nine predictive signs has a correlation, comparable in the magnitude with patient allocation into each group (based on the absolute value of gamma, ranging 0.49–0.66); the prediction accuracy is 60–74%, with a positive predictive value of 35-49%. The measure of the gamma relationship for splitting patients among groups by the original method based on nine features in conjunction with each other was -0.79 (p<0.001). Conclusion — Prediction of recurrent bleeding by one or two signs is inferior in informational content (although insignificantly) to the multifactorial method. The developed method for predicting the recurrence of ulcer bleeding from nine signs has an optimal ratio of sensitivity and specificity, which ensures a prediction accuracy of over 70% and a positive predictive value of 68.9%.
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Comparison of three risk scores to predict outcomes in upper gastrointestinal bleeding; modifying Glasgow-Blatchford with albumin. ACTA ACUST UNITED AC 2020; 57:322-333. [PMID: 31268861 DOI: 10.2478/rjim-2019-0016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Management of upper gastrointestinal bleeding (UGIB) is of great importance. In this way, we aimed to evaluate the performance of three well known scoring systems of AIMS65, Glasgow-Blatchford Score (GBS) and Full Rockall Score (FRS) in predicting adverse outcomes in patients with UGIB as well as their ability in identifying low risk patients for outpatient management. We also aimed to assess whether changing albumin cutoff in AIMS65 and addition of albumin to GBS add predictive value to these scores. METHODS This was a retrospective study on adult patients who were admitted to Razi hospital (Rasht, Iran) with diagnosis of upper gastrointestinal bleeding between March 21, 2013 and March 21, 2017. Patients who didn't undergo endoscopy or had incomplete medical data were excluded. Initially, we calculated three score systems of AIMS65, GBS and FRS for each patient by using initial Vital signs and lab data. Secondary, we modified AIMS65 and GBS by changing albumin threshold from <3.5 to <3.0 in AIMS65 and addition of albumin to GBS, respectively. Primary outcomes were defined as in hospital mortality, 30-day rebleeding, need for blood transfusion and endoscopic therapy. Secondary outcome was defined as composition of primary outcomes excluding need for blood transfusion. We used AUROC to assess predictive accuracy of risk scores in primary and secondary outcomes. For albumin-GBS model, the AUROC was only calculated for predicting mortality and secondary outcome. The negative predictive value for AIMS65, GBS and modified AIMS65 was then calculated. RESULT Of 563 patients, 3% died in hospital, 69.4% needed blood transfusion, 13.1% needed endoscopic therapy and 3% had 30-day rebleeding. The leading cause of UGIB was erosive disease. In predicting composite of adverse outcomes all scores had statistically significant accuracy with highest AUROC for albumin-GBS. However, in predicting in hospital mortality, only albumin-GBS, modified AIMS65 and AIMS65 had acceptable accuracy. Interestingly, albumin, alone, had higher predictive accuracy than other original risk scores. None of the four scores could predict 30-day rebleeding accurately; on the contrary, their accuracy in predicting need for blood transfusion was high enough. The negative predictive value for GBS was 96.6% in score of ≤2 and 85.7% and 90.2% in score of zero in AIMS65 and modified AIMS65, respectively. CONCLUSION Neither of risk scores was highly accurate as a prognostic factor in our population; however, modified AIMS65 and albumin-GBS may be optimal choice in evaluating risk of mortality and general assessment. In identifying patient for safe discharge, GBS ≤ 2 seemed to be advisable choice.
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Horibe M, Ogura Y, Matsuzaki J, Kaneko T, Yokota T, Okawa O, Nakatani Y, Iwasaki E, Nishizawa T, Hosoe N, Masaoka T, Yahagi N, Namiki S, Kanai T. Absence of high-risk stigmata predicts good prognosis even in severely anemic patients with suspected acute upper gastrointestinal bleeding. United European Gastroenterol J 2018; 6:684-690. [PMID: 30083330 PMCID: PMC6068778 DOI: 10.1177/2050640618764161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/24/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The need for a blood transfusion, defined as hemoglobin < 70 g/L, is the measure for assessing the risk levels in patients with upper gastrointestinal bleeding (UGIB). However, not all patients with a low hemoglobin level have a poor prognosis. OBJECTIVE We assessed the clinical predictive factors associated with poor short-term prognosis in patients with a low hemoglobin level. METHODS In this prospective cohort study, all consecutive patients with suspected acute UGIB at Tokyo Metropolitan Tama Medical Center were enrolled between 2008 and 2015. Then, we extracted those who needed a blood transfusion (hemoglobin < 70 g/L) and explored the variables associated with all-cause mortality within 28 days after presentation. RESULTS Among 1307 patients, 311 needed a blood transfusion and 13 (4.2%) died from all causes. The presence of high-risk stigmata requiring endoscopic treatment (peptic ulcers; Forrest scores Ia, Ib and IIa; varices with current bleeding or signs of recent bleeding; and spurting or gushing bleeding or visible vessel in other diseases), diagnosed by emergency endoscopy, was a unique factor affecting mortality (odds ratio: 8.47, 95% confidence interval: 1.45-160, P = 0.01). Patients without high-risk stigmata neither died from UGIB nor had rebleeding, irrespective of the hemoglobin levels. CONCLUSIONS Patients without high-risk stigmata showed a good prognosis even if they needed a blood transfusion. This result could facilitate triage of patients with suspected acute UGIB who only need a blood transfusion.
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Affiliation(s)
- Masayasu Horibe
- Division of Gastroenterology and Hepatology,
Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Gastroenterology and Hepatology,
Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Yuki Ogura
- Department of Gastroenterology and Hepatology,
Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Juntaro Matsuzaki
- Division of Gastroenterology and Hepatology,
Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
- Division of Molecular and Cellular Medicine,
National Cancer Center Research Institute, Tokyo, Japan
| | - Tetsuji Kaneko
- Clinical Research Support Center, Tokyo
Metropolitan Children’s Medical Center, Tokyo, Japan
- Teikyo Academic Research Center, Teikyo
University, Tokyo, Japan
| | - Takuya Yokota
- Department of Gastroenterology and Hepatology,
Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
- Department of Gastrointestinal Medicine,
Obihiro Daiich Hospital, Obihiro City, Japan
| | - Osamu Okawa
- Department of Gastroenterology and Hepatology,
Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
- Department of Gastrointestinal Medicine,
Dokkyo Medical University Koshigaya Hospital, Koshigaya City, Japan
| | - Yukihiro Nakatani
- Department of Gastroenterology and Hepatology,
Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
- Department of Endoscopy, National Cancer
Center, Tokyo, Japan
| | - Eisuke Iwasaki
- Division of Gastroenterology and Hepatology,
Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Toshihiro Nishizawa
- Division of Gastroenterology and Hepatology,
Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
- Division of Research and Development for
Minimally Invasive Treatment, Keio University School of Medicine, Tokyo, Japan
| | - Naoki Hosoe
- Center for Diagnostic and Therapeutic
Endoscopy, Keio University School of Medicine, Tokyo, Japan
| | - Tatsuhiro Masaoka
- Division of Gastroenterology and Hepatology,
Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Naohisa Yahagi
- Division of Research and Development for
Minimally Invasive Treatment, Keio University School of Medicine, Tokyo, Japan
| | - Shin Namiki
- Department of Gastroenterology and Hepatology,
Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology,
Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Zamparini E, Ahmed P, Belhassan M, Horaist C, Bouguerba A, Ayed S, Barchasz J, Boukari M, Goldgran-Toledano D, Yaacoubi S, Bornstain C, Nahon S, Vincent F. Orientation des patients adultes consultant aux urgences pour hémorragie digestive (hors hypertension portale prouvée ou présumée) : intérêt des scores pronostiques. MEDECINE INTENSIVE REANIMATION 2017. [DOI: 10.1007/s13546-017-1288-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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9
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Quach DT, Dao NH, Dinh MC, Nguyen CH, Ho LX, Nguyen NDT, Le QD, Vo CMH, Le SK, Hiyama T. The Performance of a Modified Glasgow Blatchford Score in Predicting Clinical Interventions in Patients with Acute Nonvariceal Upper Gastrointestinal Bleeding: A Vietnamese Prospective Multicenter Cohort Study. Gut Liver 2017; 10:375-81. [PMID: 26601829 PMCID: PMC4849690 DOI: 10.5009/gnl15254] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND/AIMS To compare the performance of a modified Glasgow Blatchford score (mGBS) to the Glasgow Blatchford score (GBS) and the pre-endoscopic Rockall score (RS) in predicting clinical interventions in Vietnamese patients with acute nonvariceal upper gastrointestinal bleeding (ANVUGIB). METHODS A prospective multicenter cohort study was conducted in five tertiary hospitals from May 2013 to February 2014. The mGBS, GBS, and pre-endoscopic RS scores were prospectively calculated for all patients. The accuracy of mGBS was compared with that of GBS and preendoscopic RS using area under the receiver operating characteristic curve (AUC). Clinical interventions were defined as blood transfusions, endoscopic or radiological intervention, or surgery. RESULTS There were 395 patients including 128 (32.4%) needing endoscopic treatment, 117 (29.6%) requiring blood transfusion and two (0.5%) needing surgery. In predicting the need for clinical intervention, the mGBS (AUC, 0.707) performed as well as the GBS (AUC, 0.708; p=0.87) and outperformed the pre-endoscopic RS (AUC, 0.594; p<0.001). However, none of these scores effectively excluded the need for endoscopic intervention at a threshold of 0. CONCLUSIONS mGBS performed as well as GBS and better than pre-endoscopic RS for predicting clinical interventions in Vietnamese patients with ANVUGIB. (Gut Liver 2016;10375- 381).
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Affiliation(s)
- Duc Trong Quach
- Department of Internal Medicine, University of Medicine and Pharmacy, Hochiminh City, Ho Chi Minh, Vietnam.,Department of Gastroenterology, Gia-Dinh People's Hospital, Ho Chi Minh, Vietnam
| | - Ngoi Huu Dao
- Department of Gastroenterology, An-Binh Hospital, Ho Chi Minh, Vietnam
| | - Minh Cao Dinh
- Department of Gastroenterology, Dong-Nai General Hospital, Ho Chi Minh, Vietnam
| | - Chung Huu Nguyen
- Department of Internal Medicine, University of Medicine and Pharmacy, Hochiminh City, Ho Chi Minh, Vietnam.,Department of Gastroenterology, Trung-Vuong Emergency Center, Ho Chi Minh, Vietnam
| | - Linh Xuan Ho
- Department of Gastroenterology, Gia-Dinh People's Hospital, Ho Chi Minh, Vietnam
| | - Nha-Doan Thi Nguyen
- Department of Internal Medicine, University of Medicine and Pharmacy, Hochiminh City, Ho Chi Minh, Vietnam.,Department of Gastroenterology, Nguyen-Tri-Phuong Hospital, Ho Chi Minh, Vietnam
| | - Quang Dinh Le
- Department of Internal Medicine, University of Medicine and Pharmacy, Hochiminh City, Ho Chi Minh, Vietnam.,Department of Gastroenterology, Gia-Dinh People's Hospital, Ho Chi Minh, Vietnam
| | - Cong Minh Hong Vo
- Department of Gastroenterology, Gia-Dinh People's Hospital, Ho Chi Minh, Vietnam
| | - Sang Kim Le
- Department of Gastroenterology, Trung-Vuong Emergency Center, Ho Chi Minh, Vietnam
| | - Toru Hiyama
- Health Service Center, Hiroshima University, Higashihiroshima, Japan
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10
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Monteiro S, Gonçalves TC, Magalhães J, Cotter J. Upper gastrointestinal bleeding risk scores: Who, when and why? World J Gastrointest Pathophysiol 2016; 7:86-96. [PMID: 26909231 PMCID: PMC4753192 DOI: 10.4291/wjgp.v7.i1.86] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 09/02/2015] [Accepted: 12/11/2015] [Indexed: 02/06/2023] Open
Abstract
Upper gastrointestinal bleeding (UGIB) remains a significant cause of hospital admission. In order to stratify patients according to the risk of the complications, such as rebleeding or death, and to predict the need of clinical intervention, several risk scores have been proposed and their use consistently recommended by international guidelines. The use of risk scoring systems in early assessment of patients suffering from UGIB may be useful to distinguish high-risks patients, who may need clinical intervention and hospitalization, from low risk patients with a lower chance of developing complications, in which management as outpatients can be considered. Although several scores have been published and validated for predicting different outcomes, the most frequently cited ones are the Rockall score and the Glasgow Blatchford score (GBS). While Rockall score, which incorporates clinical and endoscopic variables, has been validated to predict mortality, the GBS, which is based on clinical and laboratorial parameters, has been studied to predict the need of clinical intervention. Despite the advantages previously reported, their use in clinical decisions is still limited. This review describes the different risk scores used in the UGIB setting, highlights the most important research, explains why and when their use may be helpful, reflects on the problems that remain unresolved and guides future research with practical impact.
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11
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Kim JS, Kim BW. Risk Strategy in Non-Variceal Upper Gastrointestinal Bleeding. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2016. [DOI: 10.7704/kjhugr.2016.16.4.173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Joon Sung Kim
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Byung-Wook Kim
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
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12
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Hoffmann V, Neubauer H, Heinzler J, Smarczyk A, Hellmich M, Bowe A, Kuetting F, Demir M, Pelc A, Schulte S, Toex U, Nierhoff D, Steffen HM. A Novel Easy-to-Use Prediction Scheme for Upper Gastrointestinal Bleeding: Cologne-WATCH (C-WATCH) Risk Score. Medicine (Baltimore) 2015; 94:e1614. [PMID: 26402828 PMCID: PMC4635768 DOI: 10.1097/md.0000000000001614] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Acute upper gastrointestinal bleeding (UGIB) is the leading indication for emergency endoscopy. Scoring schemes have been developed for immediate risk stratification. However, most of these scores include endoscopic findings and are based on data from patients with nonvariceal bleeding. The aim of our study was to design a pre-endoscopic score for acute UGIB--including variceal bleeding--in order to identify high-risk patients requiring urgent clinical management. The scoring system was developed using a data set consisting of 586 patients with acute UGIB. These patients were identified from the emergency department as well as all inpatient services at the University Hospital of Cologne within a 2-year period (01/2007-12/2008). Further data from a cohort of 322 patients who presented to our endoscopy unit with acute UGIB in 2009 served for external/temporal validation.Clinical, laboratory, and endoscopic parameters, as well as further data on medical history and medication were retrospectively collected from the electronic clinical documentation system. A multivariable logistic regression was fitted to the development set to obtain a risk score using recurrent bleeding, need for intervention (angiography, surgery), or death within 30 days as a composite endpoint. Finally, the obtained risk score was evaluated on the validation set. Only C-reactive protein, white blood cells, alanine-aminotransferase, thrombocytes, creatinine, and hemoglobin were identified as significant predictors for the composite endpoint. Based on the regression coefficients of these variables, an easy-to-use point scoring scheme (C-WATCH) was derived to estimate the risk of complications from 3% to 86% with an area under the curve (AUC) of 0.723 in the development set and 0.704 in the validation set. In the validation set, no patient in the identified low-risk group (0-1 points), but 38.7% of patients in the high-risk group (≥ 2 points) reached the composite endpoint. Our easy-to-use scoring scheme is able to distinguish high-risk patients requiring urgent endoscopy, from low-risk cases who are suitable candidates for outpatient management or in whom endoscopy may be postponed. Based on our findings, a prospective validation of the C-WATCH score in different patient populations outside the university hospital setting seems warranted.
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Affiliation(s)
- Vera Hoffmann
- From the Clinic for Gastroenterology and Hepatology, University Hospital of Cologne, Kerpener Str. 62, Köln, Germany (HV, NH, HJ, SA, BA, KF, DM, PA, SS, TU, ND, SHM); Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Kerpener Str. 62, Köln, Germany (HM)
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Prospective multicenter validation of the Glasgow Blatchford bleeding score in the management of patients with upper gastrointestinal hemorrhage presenting at an emergency department. Eur J Gastroenterol Hepatol 2015; 27:1011-6. [PMID: 26049709 DOI: 10.1097/meg.0000000000000402] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS The Glasgow Blatchford Bleeding Score (GBS) has been developed to assess the need for treatment in patients with acute upper gastrointestinal hemorrhage (UGIH) presenting at emergency departments (EDs). We aimed (a) to determine the validity of the GBS and Rockall scoring systems for prediction of need for treatment and (b) to identify the optimal cut-off value of the GBS. METHODS We carried out a population-based, prospective multicenter study of 520 consecutive patients presenting with acute UGIH at EDs of three hospitals. The accuracy of GBS and Rockall scores in predicting the need for treatment (i.e. endoscopic, surgical, or radiological intervention and blood transfusion) was analyzed using receiver operating characteristic curves. RESULTS Receiver operating characteristic curve analysis showed that the GBS had a good discriminative ability to determine the need for treatment in patients with acute UGIH (area under the curve: 0.88; 95% confidence interval: 0.85-0.91). The GBS was superior to both the clinical Rockall and the full Rockall score in predicting the need for treatment (area under the curve: 0.86 vs. 0.70 vs. 0.77). At a cut-off value of up to 2, the GBS had the optimal combination of sensitivity (99.4%) and specificity (42.4%). CONCLUSION The GBS is superior compared with both Rockall scores in predicting the need for treatment in patients with suspected acute UGIH presenting at EDs in the Netherlands. Patients with a GBS of 2 or less form a subgroup of low-risk patients. These low-risk patients are eligible for outpatient management, which might reduce hospital admissions and healthcare costs.
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Chiu PWY, Chan FKL. Upper gastrointestinal bleeding: risk scores and clinical judgment in predicting outcomes of UGIB. Nat Rev Gastroenterol Hepatol 2014; 11:399-401. [PMID: 24935417 DOI: 10.1038/nrgastro.2014.98] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Predicting outcomes in upper gastrointestinal bleeding (UGIB) is important for identifying patients at high risk of morbidity and mortality who would benefit from early intervention. Various scoring systems have been developed to this end, but could clinical judgment replace or complement these risk stratification scores?
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Affiliation(s)
- Philip W Y Chiu
- Department of Surgery, Prince of Wales Hospital, 30-32 Ngan Shing Street, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Francis K L Chan
- Department of Medicine & Therapeutics, Prince of Wales Hospital, 30-32 Ngan Shing Street, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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